Failure to Provide Dignified Incontinence Care Prior to Resident Leave
Penalty
Summary
A deficiency occurred when a resident with Alzheimer's disease and severe cognitive impairment, who was dependent on staff for toileting and hygiene due to bowel incontinence, was not provided with appropriate incontinence care prior to leaving the facility for a hospital visit. Surveyor observation revealed that a Certified Medication Technician escorted the resident to the lobby and out to a family member while the resident had a strong odor of fecal incontinence. The resident was visibly soiled, with loose stool running down their pants and into their shoes, which was immediately noticed by the family member and the surveyor. The family member, who had called ahead to arrange for the resident to be ready for a hospital visit with a dying spouse, was visibly upset and questioned why the resident was handed over in such a condition. The staff member who escorted the resident did not acknowledge the incontinence, and the Director of Nursing Services confirmed that the expectation was for residents to be clean and have incontinence care provided before leaving the facility. No evidence was provided to show that the resident was treated with respect and dignity in this instance.